One of the most devastating tragedies that can befall young parents is the sudden death of their infant. When the death is unexplained by history or a thorough examination, including an autopsy, it is defined as Sudden Infant Death Syndrome (SIDS). SIDS is the leading cause of death in infants between the ages of one month and 12 months in the U.S. and has an incidence of 1-2/1000 live births or 5,000 to 6,000 deaths per year. This translates into one third to one half of all deaths in the one month to one year age group.

What is SIDS about?

The peak age for SIDS is two to four months, and it most often occurs during sleep. More cases happen during winter months, but SIDS can occur any time of year. Certain groups of infants are at a somewhat higher risk, including premature infants, boys, and infants born to substance-abusing mothers. Other risk factors are tobacco smoke exposure and prone sleeping position (face down). In the United States there is a higher rate among African-Americans. There are currently no diagnostic tests to identify individual infants at risk.

There is often little or no warning for the shocked parents, with less than 10 percent of SIDS victims having had a history of apparent life threatening events (ALTEs). ALTEs are characterized by some combination of apnea (cessation of breathing), color change (usually pale or blue/gray), and choking or gagging, and are understandably frightening to the observer, who may fear that the infant has died. Previous terms to describe these incidents as “aborted crib death” or “near death” wrongly imply a close association between ALTEs and SIDS. In fact, most infants with an ALTE do not subsequently have SIDS.

Causes and risk factors:

The cause of SIDS is unknown, although there are several theories. Many doctors and researchers now believe that SIDS is not a single condition that is always caused by the same medical problems, but infant death caused by several different factors.

These factors may include problems with sleep arousal or an inability to sense a build-up of carbon dioxide in the blood. Almost all SIDS deaths occur without any warning or symptoms when the infant is thought to be sleeping.

SIDS is most likely to occur between 2 and 4 months of age, and 90% occur by 6 months of age. It occurs more often in winter months, with the peak in January. There is also a greater incidence in Native Americans and African Americans.

The following factors increase the risk of SIDS:

  • Babies who have soft bedding in the crib
  • Multiple birth babies
  • Premature babies
  • Babies with a sibling who had SIDS
  • Mothers who smoke or use illegal drugs
  • Teen mothers
  • Short intervals between pregnancies
  • Late or no prenatal care
  • Situations of poverty
  • Babies who sleep on their stomachs(Stomach sleeping)

Boys are affected more than girls. While studies show that babies with these risk factors are more likely to be affected, the impact or importance of each factor is not well-defined or understood.

Stomach sleeping. Foremost among these risk factors is stomach sleeping. Numerous studies have found a higher incidence of SIDS among babies placed on their stomachs to sleep than among those sleeping on their backs or sides. Some researchers have hypothesized that stomach sleeping puts pressure on a child’s jaw, therefore narrowing the airway and hampering breathing.

Another theory is that stomach sleeping can increase an infant’s risk of “rebreathing” his or her own exhaled air, particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near the face. In that scenario, the soft surface could create a small enclosure around the baby’s mouth and trap exhaled air. As the baby breathes exhaled air, the oxygen level in the body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could contribute to SIDS.

How is SIDS diagnosed?

The diagnosis of SIDS is given when the cause of death remains unexplained after a complete investigation, which includes the following:

  • an autopsy
  • examination of the death scene
  • review of the symptoms or illnesses the infant had prior to dying
  • any other pertinent medical history

Tips for Reducing the Risk of SIDS

In addition to placing healthy infants on their backs to sleep, the AAP suggests the following measures to help reduce the risk of SIDS:

  • Place your baby on a firm mattress to sleep, never on a pillow, waterbed, sheepskin, or other soft surface. To prevent rebreathing, do not put blankets, comforters, stuffed toys, or pillows near the baby.
  • Make sure your baby does not get too warm while sleeping. Keep the room at a temperature that feels comfortable for an adult in a short-sleeve shirt. Some researchers suggest that a baby who gets too warm could go into a deeper sleep, making it more difficult to awaken.
  • Do not smoke, drink, or use drugs while pregnant and do not expose your baby to secondhand smoke. Infants of mothers who smoked during pregnancy are three times more likely to die of SIDS than those whose mothers were smoke-free; exposure to secondhand smoke doubles a baby’s risk of SIDS. Researchers speculate that smoking might affect the central nervous system, starting prenatally and continuing after birth, which could place the baby at increased risk.
  • Receive early and regular prenatal care.
  • Make sure your baby has regular well-baby checkups.
  • Breastfeed, if possible. There is some evidence that breastfeeding may help decrease the incidence of SIDS. The reason for this is not clear, though researchers think that breast milk may help protect babies from infections that increase the risk of SIDS.
  • If your baby has GERD, be sure to follow your doctor’s guidelines on feeding and sleep positions.
  • Put your baby to sleep with a pacifier during the first year of life. If your baby rejects the pacifier, don’t force it. Pacifiers have been linked with lower risk of SIDS. If you’re breastfeeding, try to wait until after the baby is 1 month old so that breastfeeding can be established.
  • While infants can be brought into a parent’s bed for nursing or comforting, parents should return them to their cribs or bassinets when they’re ready to sleep. It’s a good idea to keep the cribs and bassinets in the room where parents’ sleep. This has been linked with a lower risk of SIDS.

For parents and families who have experienced a SIDS death, there are many groups, including the Sudden Infant Death Syndrome Alliance, that provide grief counseling, support, and referrals. Growing public awareness of SIDS and the steps to reduce infants’ risk of sudden death hopefully will leave fewer parents searching for answers in the future.

Sources: Umm, Health Scout

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